Neruo anatomy/function Flashcards

1
Q

What is Wernicke’s area?

A

On L side of brain–>deals with understanding written & oral language

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2
Q

If are treating a pt with a CVA/TBI/SCI who has increased tone, hyperflexes, spasms and + clonus. What type of motor impairment do you suspect?

A

UMN

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3
Q

If a patient has GB or perhipheral nerve injury what motor impairments would you expect?

A

Low tone, hypo-reflexive, fasiculations (twitch), segmental weakness of strength

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4
Q

According to the Dynamic systems theroy what is the goal driven around?

A

goal driven around a task (body systems working towards common goal)

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5
Q

List the 10 neruoplasticty principles with examples

A
  1. use it or lose it
  2. use it and improve it
  3. specificity (need to make tasks specifc to what we want to improve)
  4. reps matter (need LOTS of reps)
  5. intensity matters (want high intesntiy-use RPE/HR)
  6. time matters (closer you are to event=better)
  7. salienace (relate it to what pt wants to do)
  8. age matters
  9. transference (if we work on something it can transfer to other things)
  10. interference
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6
Q

If a patient is practicing a skill for hours on end all at once what type of practice is being used?

A

Massed (all at once)
vs distributed=break it up

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7
Q

If a patient wants to learn to walk again and we start with just WB, then weight shifts then steps what type of practice is this?

A

Part task training

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8
Q

Define blocked and random practice

A

blocked=repeating same task over and over again
random=different skills randomly (this is better long term)

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9
Q

Your doing a screen on a neruo patient and do sensory testing simultaneously on both UE and they patient reports this as only able to feel on 1 side or just 1 feeling, what is this called?

A

Extinction phenomenon–>if you individually touch each side pt can feel it but if you do do it together they can’t

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10
Q

During an intial neruo exam a patient is found to be AAOP x 3, what does this indicate?

A

Pt is oriented to person, place, time BUT not situation

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11
Q

When conducting a light touch exam you test each dermotomal level at once. What is this type of light touch sense testing called?

A

Dermotomal testing (testing 1 per dermotomal site)
VS cortical=test each limb region 3-5 time (more quick screen)

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12
Q

A post neruo injuired patinet is in flexion synergy for both UE and LE, explain what this means?

A

Flexion UE=shoulder retreaction &/or elevation, GH flexion, abd, elbow flexion, forearm supination (high 5 position)
UE ext=pro & depression, add + IR, elbow ext, pronation
LE flexion=hip flexion, knee flexion, DF & Inversion (figure 4 like)

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13
Q

A post stroke patient is found to be able to move slightly out of UE flexion synergy. What Brunnstrong stage are they in?

A

Stage 4=out of synergy

1=flaccid (post injury)
2=synergies, some spastictisity
3=marked spasticity & synergy
4=out of synergy
5=selective control of mvmt
6=can fully move limbs

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14
Q

A PT grades a patients spasticity according to the ASH scale as 1+, what is seen in pt?

A

slight increase in tone, manifested by catch and little resistance throguh rest of ROM

0=no increase in tone
1=slight increase in tone, catch and relase or min restinace at end ROM
2=more tone through most ROM, but body part moves easily
3=considerable icnrease in tone, passive mvmt issues
4=affected parts are rigid and high tone

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15
Q

Explain ideal plumb limb alignment

A

Through mastoid process, in front of shoulder, just behidn axis of hip jt, in front of knee, ant to medial malleous

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16
Q

If a patient is pushed from behind to test perturbation strategy what muscles should contract first?

A

Distal to proximal calves, HS, paraspinals

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17
Q

When testing a patients ability to respond to push from behind perturbations you noticed they contract posterior muscles in response prior to the push, what postural control mechanism is this?

A

Feed fwd (anticipatory control) before perturbations (proactive)’ provides internal perturbations
VS reactive would be more like pull test (external perturbation)

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18
Q

A patient is tested on the m-CTSIB with eyes open and on foam surface. What level is this?

A

Level 3=answer
Level 1=eyes open-stable surface
2=Eyes closed on hard surface (vision is taken away)
3=eyes open + foam surface (Vision + vestibular in tact)
4= eyes closed + foam surface (vestibular only one in tact)

19
Q

Describe the levels of a sensory organization test (SOT)

A

1=Eyes open on firm surface (testing all 3)
2. Eyes closed on firm surface (testing somato & vestib)
3. Eyes open with sway referenced visual surround (vision not reliable; testing if they rely on visual info to help)
4. Eyes open on sway referenced support surface (normal vision)-testing somatosensory with sway referenced)
5. Eyes closed on sway referenced support surface (testing vestibular)
6. Eyes open on sway referenced support surface and surround (testing vestibular)
**review this

20
Q

If a patients presents post TBI with ipsilateral impairments what location is the issues?

A

Cerebellum

21
Q

A TBI patient shows signs of nystagmus, increased sway and impaired balance, what brain area is impacted?

A

cerebullum (vestbiulocerebellum)

22
Q

a post TBI patient has trouble with complex tasks and fine motor skills. They are slow to start tasks and show more UE > LE involvement, what areas is the lesion?

A

Cerebellar (cerebrocerebellar)-unilateral

23
Q

List 10 cerebellar deficits if a patient has an injury to that area

A

ataxia, dyssynergies mvmt, dysarthria (speech formation issues), intention tremor, dysmetria (missing target in reach), hypotonic & reflexive, abnormal gait

24
Q

You notice a patients nystagmus beats to the R side. Which side could injury be on?

A

Opposite side, (side of increased neural activity)
So if L stroke/loss–>will see R beating/mvmt of both eyes

25
Q

A patient shows lateral nystagmus with vertigo that lasts < 1 minutes with beats to the R with R rotation with Dix Hall Pike. Where is the issue?

A

Horizontal canal BPPV (nystagmus is geotrophic=eats to ground)–Canalithisis (intiital delay and then Sx’s start)

26
Q

in Cupulothiasis how long is nystagmus and what ways do eyes beta?

A

1+ minute and ageotropic (beats away from ground)
This is cupulotiasis

27
Q

A TBI pt is confused but answers appropriatly to questions asked, what level on the Rancho Los amigos scale is this?

A

Level 6 (mod assist w/ 30 mins attention)

28
Q

What rancho los amigos level can a TBI patient in the hospital start to learn info?

A

Level 7=automatic & appropriate responses

Level 1=no response
2=generalized response
3=localized response
4=confused & agitated
5=confused, inappropriate responses, non-agiated
8-10=purposeful an dappropriate mvmts (will be SBA)

29
Q

A patient has issues in planning tasks, where is the lesion?

A

Planning is the frontal lobe (also executive function, decision making)
temporal=memory more, explicit learning

30
Q

List major areas of brain and general function of each

A

Occipital=vision, impaired facial recognition, depth perception
Temporal=speech, may have issue understanding speech if issue, emotions, memory
Frontal=irritablity, personality, attention
Cerebellum=balance issues, ataxia, VOR, convergence, dysmetria, coordiation
Brain stem=decerebrate posture (hands at side & worst kind), insomina, Para NS

31
Q

You read in a chart that a patient has a GCS of 13, should you precede with PT?

A

Yes you may this is mild severity

GCS moderate=9-12
GCS of < 8=SEVERE

32
Q

A patient opens his eyes to speech, has no responses to motor and is confused. what GCS level are they?

A

8
3 main categories (eye opening, motor response & verbal response
EO; 4=spontaneous/normal
motor=6 (follows motor commands), 5=localizes, 4=withdraws, 3=abnomral flexion, 2=externals response, 1=no response)
VR (1-5); 1=no response, 2=compressive sounds, 3=inappropriate words
4=confused conversation
5=oriented

33
Q

According to the Rancho levels, a level 3 should or shouldn’t do PT?

A

should not (minimal responsive)

6=no new learning, but some attention
can start to learn at level 7
can start to multi task at 8-10

34
Q

A patient in the ICU with Rancho level 2, what is the PT”s primary focus?

A

Proper positioning of patient

35
Q

lesion at the R optic tract would cause what vision issues?

A

homogeneous hemiopia (no vision on L side)
*review visual field defients)

36
Q

A patient has a L cerebral stroke, what impairments are seen?

A

R hemi, aphasia (receptive or expressive), apraxia, poor executive function, inappropriate behavior

R CVA= L hemi, impulsive, apraxia, poor attention, denial of how bad they are, visual issues, impulsive issues, L neglet

37
Q

A patient was diagnosed with a MCA stroke, what body regions are expected to be affected?

A

arms > legs, (MCA=most common place)
MCA=commonly have homoymous hemianopsia (loss of vision in controfal half of each vision)

ACA= LE > UE

PCA=memory/vision issues but least common stroke type

38
Q

A patient id Dx with a R sided stroke, what should you expect to see?

A

damage to R brain=L hemi, L visual neglet, impulsive behavior/poor judgement, lack of awarness, agonesia

damage to L brain=R hemi, aphasia, slow & cautious**, apraxia, speech issues

39
Q

T/F: damage to Brocas areas would cause receptive aphasia.

A

False–>receptive aphasia is damage to wernickes (pt will not know what they are saying but fluent speech)
Expressive apasia=brocas area damage (having hard time expressing what they want to say (can’t form words)
Global=can’t understand what your saying & can’t express

40
Q

If an ICU patient post stroke has BP of 190/100 and ICP of 25 are they safe to do PT?

A

no contraindicated (ICP should be < 22, keep BP < 140 mmHg

41
Q

A patient post stroke exhibits a lean over affected leg, why is this?

A

Avoid torque demands of glut muscles (this is compensated trendelenberg)

42
Q

Post stroke, what is the most appropriate intensity for a patient to be at?

A

Moderate to high intensity

43
Q

Post stroke, a patient is having trouble with shoulder ROM. The PT considers doing pullies to help with this. What should be your response?

A

Do not do pullies b/c sublux possible